Parents of obese kids may be more ready to tackle diet than exercise

NEW YORK (Reuters Health) - Parents of overweight and obese kids may want to help their kids be healthier, but they’re more often willing to make changes in children’s diets than in their activity levels, according to a new study.

Researchers found that addressing parents’ beliefs about themselves and their kids, and encouraging doctors to talk about the importance of physical activity could remove important obstacles to obese childrens’ weight loss.

“We thought about doing this study because when we worked with families to try to engage them in weight loss, we noticed differences in parent’s readiness to change dietary behaviors versus physical activity behaviors,” said Dr. Kyung Rhee, who was at Brown University in Providence, Rhode Island, when she led the study.

“They weren’t always ready to do both – some families were ready to do one versus the other, but when you’re really trying to engage in weight loss, it’s important to engage in both,” said Rhee, a pediatrician at the University of California, San Diego.

For the study, published in the Journal of the Academy of Nutrition and Dietetics, Rhee and her colleagues surveyed the parents of 202 overweight and obese children who attended a Providence obesity clinic from November 2008 to August 2009.

The surveys assessed the readiness of parents to make behavioral changes around their children’s eating patterns and exercises habits. Parents were also asked about their own weight and health, and their perceptions of their child’s health.

Many of the children had the pre-diabetes condition known as impaired glucose tolerance or had high cholesterol levels, but 31 percent of parents thought their child’s health was excellent and 28 percent didn’t believe their child’s weight was a health problem.

The researchers were interested in where parents fell along a spectrum of readiness to make changes according to a psychology theory about how people transform their behaviors, such as quitting smoking or losing weight, and what factors influenced the parents’ willingness to change.

Based on the survey responses, they divided parents into three categories, including those in the precontemplation/contemplation stage, who had not made behavior changes and weren’t planning to make any for their child within the next six months.

The second category was made up of parents who had made a few changes or planned to make changes during the next month and were considered to be in the preparation stage of change.

Parents who had made changes more than once a week for at least a month were considered to be in the action/maintenance stage, indicating they were the most ready to act to address their child’s weight problem.

With regard to helping their children make dietary changes, about 17 percent of parents were in the precontemplation/contemplation stage, 21 percent were in the preparation stage and 61 percent were in the action/maintenance stage.

When it came to physical activity changes, however, 41 percent of parents were in the precontemplation/contemplation stage, 18 percent were in the preparation stage and about 41 percent were in the action/maintenance stage.

The study team noted that children of parents in the action/maintenance stage for diet were already eating less fast food and more fruits and vegetables compared to other kids. Those whose parents were in the action/maintenance stage for physical activity were already more active than their peers.

When the researchers looked at factors linked to the parents’ readiness to make changes, they found that parents who believed their own weight was a health problem were less ready to make changes to their children’s diets.

They also discovered that parents with older children were less likely to be in the action/maintenance stage for physical activity.

Rhee pointed out that this survey was done among parents whose kids were going through an obesity and endocrine clinic. “And even in that setting only 60 percent were ready to make dietary changes and only 40 percent were ready to make physical activity changes,” she said.

“So I think if you were to do this in a population of non-treatment seeking families, I’d be afraid that the readiness levels would be a lot lower, which I think speaks to the difficulty of what we’re trying to do to get people to lose weight,” she said.

The parents indicated that a doctor’s recommendation for making dietary changes was influential, Rhee and her colleagues note in their report. That suggests doctors could also play bigger role in helping parents find ways to improve a child’s physical activity levels, they write.

The researchers also speculate that parents who think their own weight is a health problem may feel frustrated or overwhelmed by past failures to lose weight themselves. And that parents of older children may feel they have less control over the child’s eating and activity levels during the day than they would with a younger child.

Rhee told Reuters Health the study results indicate that pediatricians should consider talking to parents about their own weight history and feelings about trying to change their own dietary behaviors.

“Overall I think the notion of stages of change has great applicability representing a way to tap into levels of motivation and action,” Kenneth Gruber told Reuters Health in an email.

“I think the article addresses a very important topic and highlights issues that need more attention,” said Gruber, a research psychologist with the Center for Youth, Family and Community Partnerships at the University of North Carolina Greensboro, who was not involved in the study.

Because the study looked at only one point in time, he cautioned, it doesn’t show whether or how parents progressed from one stage to another or if the changes made were always positive.

Gruber said that people in the contemplative stage usually will at least try to become more active – but many factors including success of the effort, adequate resources to support the effort and being able to control the outcomes of the effort come into play.

“For example, a parent may want his/her child to be more physically active, but live in an unsafe neighborhood and have little free time to take the child to safe play venues,” Gruber said.

He added that he was pleased the authors noted the importance of doctor-parent child weight discussions.

“This is an issue that deserves more attention because primary care physicians are reluctant to talk with parents and children about weight issues,” he said.

SOURCE: bit.ly/UeUpXz Journal of the Academy of Nutrition and Dietetics, online June 23, 2014.

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